Healthcare Provider Details

I. General information

NPI: 1578953642
Provider Name (Legal Business Name): KRISTIN WENTZ-KRUMWIEDE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SECOND AVENUE NORTH EAST
CARSON ND
58529-0278
US

IV. Provider business mailing address

106 2ND AVE
CARSON ND
58529
US

V. Phone/Fax

Practice location:
  • Phone: 701-622-3706
  • Fax: 701-622-3045
Mailing address:
  • Phone: 701-622-3706
  • Fax: 701-622-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4860
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: